The American Influenza Epidemic of 1918-1919:

A Digital Encyclopedia

Chicago, Illinois

“First in violence, deepest in dirt; loud, lawless, unlovely, ill-smelling, irreverent, new; an overgrown gawk of a village,” journalist Lincoln Steffens described the Windy City in 1903.1 From its start as a marshy portage for Native American and French trappers and traders, Chicago grew to a bustling metropolis of 2.7 million by the time influenza arrived on September 8, 1918, when a few sailors at the nearby Great Lakes Naval Training Station fell ill with the disease. A week later, seven army cadets from the Northwestern University SATC unit came down with influenza. Then, a few days after that, cases developed among cadets at the Lewis Institute SATC unit on South Hoyne Street in Chicago itself. The epidemic had begun.

Military officials acted quickly in an attempt to contain the disease. At Great Lakes Naval Training Station, officers instituted isolation and quarantine controls, ordered all 50,000 sailors to be given daily nose and throat sprays (where, presumably, they could also be quickly examined for symptoms), placed 1,000 men in isolation when they developed symptoms and an additional 4,000 sailors under quarantine for suspect contact with the ill, and cancelled all liberty leave for enlisted sailors until the epidemic had passed. Surprisingly, although sailors were prohibited from leaving Great Lakes station, civilians were still permitted to visit.2

By late-September, it appeared that the epidemic at Great Lakes station had crested. Station health officers were happy to report that the number of new cases was decreasing at a rate of approximately 10% per day. In Chicago, Health Commissioner Dr. John Dill Robertson announced that officials had “the Spanish influenza situation well in hand now.”3 To monitor the situation, Robertson made influenza a reportable disease on September 16, but took no further action.4

Chicago’s epidemic, however, had only just begun. On September 21, city health officials took note of a sudden marked rise in the number of deaths due to acute respiratory diseases.5 By September 30, there were 260 cases in the city. The large and sudden jump in new cases led Health Commissioner Robertson to order the immediate isolation at Cook County Hospital of all known cases. Realizing that hospital isolation would soon become impossible, he told residents to prepare to isolate themselves should they become sick. “Every victim of the disease is commanded to go to his home and stay there,” he announced. “No visitors are to be allowed.”6

Robertson was hesitant to implement any further epidemic control measures that might disrupt life or lower morale, and he therefore moved in a slow, step-wise fashion. A survey of the city’s schools showed that Chicago children had thus far managed to escape the brunt of the epidemic, and attendance was still nearly normal despite excluding all students with cold or flu-like symptoms. Schools were therefore to remain open. Robertson and representatives of the city’s various child welfare agencies and organizations believed that children were better off in schools anyway, where they were under watch and kept from roaming the streets.

Despite his hesitation, Health Commissioner Robertson did ask Chief of Police John Alcock to have his officers stop all persistent sneezers and coughers who did not cover their faces with handkerchiefs. Those violators who promised to obey instructions in the future would be let go, but anyone who gave the officer a difficult time would be arrested, given a lecture on the dangers of influenza, and sent before a judge for arraignment.7 Robertson also warned theater managers and owners to ensure patrons used handkerchiefs or he would shut down their establishments. Churches, schools, theaters, restaurants, streetcars, and other places where people congregated were ordered to maintain proper ventilation.8 For the time being, these were the extent of Chicago’s control measures. Both Robertson and the Illinois Influenza Advisory Commission agreed that no closure order should be issued, arguing that the epidemic was “practically at a standstill” in Chicago and the northern part of the state.9

Chicago may not have needed a public gathering ban yet, but it did need more nurses. On October 11, the Chicago chapter of the American Red Cross issued an urgent call for volunteers. Highlighting the plight of the city’s ill and playing on the heartstrings of women across the region, the Red Cross printed the story of a nurse who made a house call expecting to find a sick mother. Instead, she discovered that the entire family was stricken with influenza: the mother and two young children were all bedridden with high fevers, a 10-month old baby was starving, and the father was wandering the streets in fevered delirium, desperately trying to find a physician to care for his family. “This case,” the Red Cross coordinator wrote, “tells its own story and makes its own appeal to the womanhood of Chicago.”1 The city’s settlement houses likewise called for volunteers. Some turned themselves over entirely to the epidemic cause.11 The University of Chicago Settlement House, for example, stopped all its regular activities for several weeks during the epidemic in order to host an emergency hospital and diet kitchen, the latter serving a total of approximately 3,000 meals.12

Perhaps because of the increasing occurrence of news such as this, the Illinois Influenza Advisory Commission slowly began changing its tune. The first steps it took were to pass a binding resolution on October 11 banning public dancing in all clubs, cabarets, and halls and to prohibit all public funerals across the state. The Commission reasoned that public dancing was a particularly efficient way both to transmit and contract influenza because of the close contact between dancers and the chilling of sweaty bodies that usually followed a rigorous dance. Receiving the news the next day, Health Officer Robertson notified Chief of Police John Alcock of the ruling and requested that officers stop all dances across the city starting that night – the first night in nearly 16 years that Chicago did not have a weekday public dance. The same day, October 12, the Commission recommended that Chicago’s transit company keep streetcar front doors open to ensure a constant stream of fresh air into the cabins. Robertson and the Commission worried that the Liberty Loan parade, held that day, would result in an increase in the number of new influenza cases, but realized there was little they could do at this late date to try to stop the event. The best that could be done was to warn parade-goers to take precautions. Unfortunately, the prescription missed the mark: Robertson told the public to head home as soon as the parade was over, put on warm clothes, and take a laxative to minimize their chances of catching influenza.13

By now, Chicago physicians were reporting a staggering number of new cases, reaching as high as 1,200 a day and climbing.14 The Illinois Influenza Advisory Commission, with Health Commissioner Robertson fully participating, now had little choice but to contemplate seriously the closure of public places. On October 14, the Commission invited representatives from professional organizations, the Red Cross, clubs and trade organizations, federal and state officials, and the Liberty Loan committee to meet at the upscale Hotel Sherman, a well known night spot for celebrities, jazz musicians, and Chicago’s high society set, to discuss the possibility of issuing a general closure order. As Robertson put it, “We wish to take no rash action, and desire to be sure that whatever we do will be for the benefit of the city.”15

After hearing from constituents, the Advisory Commission handed down its final decision: beginning on Tuesday October 15, all theaters, movie houses, and night schools were to close immediately for an indefinite period, and all lodge meetings and other similar gatherings were prohibited. The Commission included “all other places of public amusement” in its order, but acknowledged that further clarification was needed in order to determine the exact extent of the phrase.16 Churches were left off the list for the time being, since no religious services would be held for at least three more days. In the end, Chicago churches were not required to close, although clergy were asked to keep services short and their buildings well ventilated. An unintended but salutary effect was that many churches organized parishioners into soup brigades to help families stricken by influenza.17 At a time when charity and volunteer work was practically the only safety net, churches and synagogues were major centers and organizers of aid, and many did their best to alleviate as much of the ancillary suffering as they could.

Movie houses and theaters were the prime focus, as they were seen as the places most likely to cause the spread of influenza. Public schools were to remain open because of well-organized systems of medical inspection already in place. In fact, school health officers and nurses were instructed to drop all their routine work and concentrate solely on student inspections. Closing schools may have mattered little by this late date anyway, as absentee rates had already reached as high as thirty percent, and would spike to nearly fifty percent within a week. Not all of these absences were due to illness; some were the result of worried parents. Others were due to mischievous students who took to sniffing pepper in order to induce a coughing or sneezing fit, knowing that they would be sent home for a week.18

A Closed Chicago

Despite the grumblings of some residents, the closure order had the desired effect. Chicago’s loop district, home to most of the city’s entertainment district, was suddenly empty at night. Newspapers reported that the sidewalks were clear, the restaurants half deserted, and the taxicabs idle. Health Commissioner Robertson was pleased with the news.19 Theater and movie house owners and employees, naturally, were not. Estimates as to the financial losses they would suffer varied greatly, but it was generally agreed that approximately 650 theater workers and an additional 500 movie house employees were now out of work. Lost box office receipts were difficult to ascertain, but at least one theater had already sold $80,000 in advance tickets for just a single performance.20 Workers were especially hard hit. “Unfortunate now are these comely young women of the chorus,” one newspaper columnist wrote of the theater closures, “for their misfortune is not their fault. It is not to preserve their health but our health that they bravely forgot their right to earn bread and rest.”21

More businesses were about to be affected. On October 15, the Illinois Influenza Advisory Commission met to try to decide what other places of public amusement and gathering should be closed. No definite consensus could be reached, although the group did agree that ice skating rinks would be added to the list. The next day the Commission members finally concluded that all non-essential public gatherings should be banned, but that actual implementation of the recommendation should be left up to State Health Commissioner C. St. Claire Drake and local authorities. Drake immediately issued the recommendation as a statewide order, decreeing that all public gatherings of a social nature and not essential to the war effort be discontinued indefinitely. All banquets and public dinners, conventions, lectures and debates, club and society meetings, union gatherings, and athletic contests (whether indoor or out) were therefore prohibited. Saloons could remain open, as could poolrooms and bowling alleys, so long as they were properly ventilated. All other forms of gathering not expressly prohibited by the state order could continue, so long as spitters, coughers, and sneezers were kept out and crowding was not permitted.22 Both Illinois and Chicago officials continued to enact epidemic control measures in a stepwise manner.

The epidemic raged. Sad stories of influenza-stricken Chicagoans filled the pages of the city’s newspapers: Phyllis Padula and her four young children suffering from bad cases of influenza when her husband Angelo ventured out in search of a physician, only to commit suicide by jumping into the frigid Chicago River; a Spanish-American War veteran, armed with a shotgun and two revolvers and delirious with fever, in a two-hour standoff with police; a wife suffering a mental breakdown after caring for her sick husband and five children, dousing her family’s clothing in gasoline and setting the pile ablaze as they all shivered in the cold.23 In another case, Peter Marazzo killed his wife and four children by slitting their throats. Brought to trial, the jury found him not guilty by reason of insanity due to his high fever brought on by influenza. An army doctor at the trial testified that the toxins from the influenza germ had “lodged in the brain cells and wrecked Marazzo’s mind.”24 Several physicians at the time observed that various psychoses, most notably dementia praecox (schizophrenia), seemed to develop shortly after bouts with influenza.25

By the last days of October, new case reports indicated that the epidemic might be on the decline across Illinois. The Illinois Influenza Advisory Commission hesitated to recommend lifting the closure order and gather ban just yet, though, preferring to hear from local authorities as to the precise conditions in the communities. In Chicago, Health Commissioner Robertson was hopeful that the epidemic would soon be over, but believed that the control measures be kept in place for a short while longer. In the meantime, he suggested that everyone curtail his or her usual Saturday night revelry, go to bed early, and get plenty of rest on Sunday.26 To many, it sounded far too much like a dose of parenting.

Whether or not Chicagoans followed his advice, by Monday, October 28 the case tallies had declined enough to warrant serious consideration of removing the bans. Robertson and the Health Department drafted a tentative plan that called for the step-by-step and district-by-district return to normal city life over the course of a week. The next day, Tuesday the 29th, after gaining Drake’s approval, Robertson and the Chicago Health Department put the plan into action. Beginning that day, all music and entertainment could resume in the city’s restaurants, cafes, and hotels. On Wednesday the 30th, theaters and movie houses between Howard and Diversey Parkway could re-open. The following day, theaters and movie houses between Diversey Parkway and 12th Street could resume their hours. On Friday, November 1, the rest of the city could re-open. Public meetings were to follow a similar schedule starting on Thursday, with all meetings allowed in all parts of the city by Saturday, November 2. Theaters had to pass inspection before they could re-open their doors, coughers and sneezers were prohibited from entering, no crowding would be allowed, and all public places were required to close by 10 pm.27 Public dances could resume on Monday, November 4.28 The reason for the geographically staged schedule was simple: by the fourth week of the epidemic, the greatest number of new cases had occurred in the half of the city south of 12th Street, and Robertson believed that area needed a few more days before it was firmly in the clear.29

Conditions in Chicago continued to improve even as residents mixed and mingled in theaters, movie houses, cabarets, and restaurants. In most cities, the removal of social distancing measures was met with a great deal of joy. In Chicago, it was met with some grumbling, aimed primarily at Health Commissioner Robertson. During the epidemic, Robertson had banned smoking on all streetcars, elevated trains, and suburban light rail lines.30 Now that the danger had passed, however, Robertson refused to remove the no-smoking ban. Reporting on the news, the Chicago Tribune referred to Robertson as “his highness.” On November 2, Robertson ruled that city entertainment venues could remain open until 10:30 pm, adding an extra half hour to Chicago’s nightlife. Robertson advised that all revelers therefore get an extra half hour sleep on Sunday morning in return. The Tribune quickly attacked him for his paternalism, referring to him as “his eminence” repeatedly. “Chicago may disport itself tonight into the late hour of 10:30 by virtue of the gracious order of Dr. John Dill Robertson, city health commissioner,” wrote the Tribune. The following day, when the last remaining flu bans were about to be removed, the Tribune continued its attack on Robertson. “Outside of the fact that you mustn’t cough, sneeze, expectorate or osculate, mustn’t smoke on street cars or in the elevated trains, can not visit sick friends and must continue to observe the food and fuel regulations and keep up your installment payments on Liberty bonds, you can get up tomorrow and do as you darn please,” the article began. Those who wished to attend one of the long-suspended public dances could glide across the floor “without fearing the intrusion of a health department chaperon with untimely remarks about the dangers of proximity.”31 The editorial staff of the Tribune, and likely many other residents, had thoroughly tired of Robertson’s restrictions and paternalism, especially when they had been placed on top of the already onerous wartime social restrictions and civic responsibilities.

Conclusion

Between the start of Chicago’s epidemic on September 21 and the removal of restrictions on November 16, the Windy City experienced a staggering 38,000 cases of influenza and over 13,000 cases of pneumonia. The white population of the city experienced an increase in deaths of 2,610 percent over the previous year. The African American population, on the other hand, experienced an increase of only 1,400 percent. Health Commissioner Roberston attributed the difference to the intrinsic immunity to influenza and pneumonia among the city’s African American population.32 In reality, the discrepancy was likely due to racial disparities in Chicago’s health care and access: African American Chicagoans were already much more likely to die of disease than their white counterparts. Epidemic influenza, a disease that did not respect color or socioeconomic lines, therefore only appeared to attack whites with more virulence.

Doctors and nurses worked around the clock during the crisis. Morris Fishbein, a prominent Chicago doctor and later editor of the Journal of the American Medical Association, wrote in his memoirs that most Chicago physicians visited some sixty to ninety patients each day during the height of the epidemic, unable to do much besides try to make them comfortable.33 Yet, despite these staggering numbers, Chicago actually did fairly well for a city of its size. In fact, with a population of 2.7 million, Chicago’s epidemic death rate for the period was only 373 out of 100,000, not much worse than much touted (and its long-time rival) St. Louis.34

Chicago’s epidemic experience led to important changes in the city’s medical care infrastructure. In January 1919, with the main danger over, Health Commissioner Robertson turned his attention to correcting some of the shortcomings the city experienced during the crisis. Highest on his list was the nursing shortage. In 1907, after several failed attempts, the Illinois legislature had passed a law creating a board to register trained nurses after two years of schooling. At the time, Robertson opposed the bill, arguing that it would drive up the cost of nurses and create a system whereby those of only modest means would not be able to afford adequate care. “The nurse has become a necessity in our present civilization,” he argued, “but her cost has made her services a luxury that only those in good circumstances can enjoy.” He believed that any woman (and, following the sexism of the times, he considered women as natural nurses due to their innate ability to follow a man’s orders) with intensive training could be made a competent nurse in a matter of three to six months, not two or three years. If the army could churn out perfectly good officers in three months, he argued, good nurse educators should be able to do the same. Now, in the wake of the epidemic, Robertson felt an even greater sense of urgency in bolstering Chicago’s nursing corps.

To create a large contingent of these “practical nurses” as he called them, Health Commissioner Robertson suggested several changes. First, hospitals should immediately modify their curricula so that two classes of nurses could be trained. One track would become registered nurses, while the other would take six months of intensive training. Second, the state legislature should change current nursing law to allow for the training of these practical nurses as well as lower the number of years required of registered nurses from three to two. Lastly, Robertson suggested that if Illinois lawmakers did not act, then Chicago should take the lead in licensing practical nurses much the same way as it licensed undertakers. 35

His ideas were welcomed by some and angrily dismissed by others. Within a week of announcing the idea, the city’s Director of the Department of Education and Registration had already drafted a bill allowing for a one-year course of training for practical nurses, which he said he was prepared to present to the state legislature. A group of supportive physicians offered to travel to Springfield to support the bill if necessary. The Journal of the American Medical Association endorsed the idea of a separate track of practical nurses in an editorial blaming trained nurses for the current woes. A nurse should be “a true physician’s assistant and will be a household helper not too proud to assist in the kitchen or even to help care for the baby,” the editor wrote.36

On February 18, 1919, the new nursing bill was introduced in the Illinois General Assembly. The bill provided for a one-year course of training for practical nurses, granted authority to the State Board of Registration to license those who passed the training, and made it illegal to pose as a registered nurse unless entitled to do so. Hospitals, which would benefit from the lower cost of practical nurses, supported the bill. Registered nurses, who stood to lose some control over their profession and who feared a decrease in their wages, naturally opposed it. In the end, the support for the proposal was simply too strong for nurses’ groups to withstand. The bill passed.

On July 21, 1919, Chicago’s Training School for Home and Public Health Nursing opened its doors. Nearly 800 women completed the inaugural class, and within two years some 3,000 women had passed the course. When influenza returned in 1920, 600 of these graduates answered the call for volunteers, exactly as Health Commissioner Robertson had hoped they would. The program worked so well that Robertson instituted a second similar program in connection with the Municipal Tuberculosis Sanitarium in 1920.37 Never again would Chicago be faced with a critical shortage of nurses during a time of need.

4 John Dill Robertson, Report and Handbook of the Department of Health of the City of Chicago for the Years 1911 to 1918 Inclusive (Chicago: 1919), 80-82. Pneumonia had been a reportable disease in Chicago since 1910, and a placardable disease since 1916.

5 John Dill Robertson, Report and Handbook of the Department of Health of the City of Chicago for the Years 1911 to 1918 Inclusive (Chicago: 1919), 49.

10 “Help! Women Called upon to Volunteer for First Aid in Stemming Epidemic,” Chicago Tribune, 12 Oct. 1918, 5.

11 “Annual Report of the Federation of Settlements by the President, Harriet E. Vittum, for the Year Ending November 1918,” Lea Demarest Taylor Papers, Box 7, Folder 4, CFS 1917-1919, The Research Center of the Chicago History Museum, Chicago, Illinois.

12 “Report of the University of Chicago Settlement, May 1918 to May 1919,” University of Chicago Settlement Records, Box 19, Folder: Annual Reports, 1918-1930, The Research Center of the Chicago History Museum, Chicago, Illinois.

13 “Public Dancing Barred in Fight on Influenza,” Chicago Tribune, 12 Oct. 1918, 5; “You Can’t Smoke on Street Cars till Flu Ends,” Chicago Tribune, 13 Oct. 1918, 1. As a result of the ban on public dancing, Chicago went without a weekday public dance event for the first time since the infamous Iroquois Theater fire of December 30, 1903, where over 600 people died.

14 John Dill Robertson, Report and Handbook of the Department of Health of the City of Chicago for the Years 1911 to 1918 Inclusive (Chicago: 1919), 52.

22 “Influenza Shuts All Chicago,” Chicago Herald and Examiner, 18 Oct. 1918, 1, and “Cabaret’s Close, Outdoor Games Off, Flu Order,” Chicago Tribune, 18 Oct. 1918, 13. Chicago police eagerly enforced the new rules. Under an existing city ordinance, police could arrest violators and judges could issue fines ranging from $10 to $200 – a princely sum in 1918. The police were serious: on October 19, detectives raided a saloon on North Clark Street where they found twenty men asleep on the benches, ten of whom were hauled to the city’s drunk tank. A second saloon, this one on West Van Buren, was raided when police found men bellied up to the bar two deep. Fifteen violators from that bar, along with the manager, were taken to jail. See “Police Raid Saloons in War on Influenza; Keep Church Windows Open,” Chicago Herald and Examiner, 20 Oct. 1918, 3, and “All Who Peril Health of City to Be Arrested,” Chicago Tribune, 19 Oct. 1918, 13.

Chicago, Illinois

Timeline of Events

Total Excess Death Rate 373Total Deaths per 100,000 population over duration of epidemic (roughly 1918 September 14 through 1919 February 22).

1918

1919

August

September

October

November

December

January

February

March

April

Sa

27

3

10

17

24

31

7

14

21

28

5

12

19

26

2

9

16

23

30

7

14

21

28

4

11

18

25

1

8

15

22

1

8

15

22

29

5

12

19

Fr

26

2

9

16

23

30

6

13

20

27

4

11

18

25

1

8

15

22

29

6

13

20

27

3

10

17

24

31

7

14

21

28

7

14

21

28

4

11

18

Th

25

1

8

15

22

29

5

12

19

26

3

10

17

24

31

7

14

21

28

5

12

19

26

2

9

16

23

30

6

13

20

27

6

13

20

27

3

10

17

We

24

31

7

14

21

28

4

11

18

25

2

9

16

23

30

6

13

20

27

4

11

18

25

1

8

15

22

29

5

12

19

26

5

12

19

26

2

9

16

Tu

23

30

6

13

20

27

3

10

17

24

1

8

15

22

29

5

12

19

26

3

10

17

24

31

7

14

21

28

4

11

18

25

4

11

18

25

1

8

15

Mo

22

29

5

12

19

26

2

9

16

23

30

7

14

21

28

4

11

18

25

2

9

16

23

30

6

13

20

27

3

10

17

24

3

10

16

24

31

7

14

Su

21

28

4

11

18

25

1

8

15

22

29

6

13

20

27

3

10

17

24

1

8

15

22

29

5

12

19

26

2

9

16

23

2

9

15

23

30

6

13

September 16, 1918

Great Lakes Naval Training Station, some 30 miles north of Chicago, reports 200 cases of Spanish influenza. Precautions are taken to prevent influenza spreading to remaining 50,000 sailors.

September 17, 1918

Still no cases reported in Chicago, but City Health Commissioner Dr. John Dill Robertson bemoans, “Now [that] the news of this epidemic has been circulated, probably everybody who gets a bad cold or a slight fever will think they’ve caught Spanish influenza. Tell them to go to bed and lie quiet a while. It’ll pass off.”

September 19, 1918

Seven cases are reported at Northwestern Student Army Training Corps in Evanston, 20 miles north of downtown. All of the afflicted are in isolation.

September 20, 1918

Acting Chief of Police John Alcock orders all police station captains to arrest persons caught spitting.

The first cases of influenza in Chicago are reported to Health Commissioner Robertson.

September 21, 1918

30 cases of influenza are reported among students at Lewis Technical Institute.

Health Commissioner Robertson warns that influenza is highly contagious and recommends that in the case of infection a doctor be called immediately because pneumonia often follows influenza and can lead to death.

September 22, 1918

Health Commissioner Robertson notifies physicians that they must report the names of all patients showing signs of influenza.

The number of cases at Great Lakes Naval Training Station is believed to be at least 2,500.

September 23, 1918

Captain W.A. Moffett of Great Lakes Naval Training Station reports 4,500 cases of influenza and about 65 deaths.

September 24, 1918

8000 cases at Great Lakes Naval Training Station. 1400 of these remain in the hospital in serious condition.

60 cases of influenza are reported among draftees at Northwestern University.

September 25, 1918

Seventeen cases are reported throughout Chicago. Health authorities recommend that those exposed to influenza wear gauze masks to prevent catching it. Notices are posted asking citizens to cover their nose and mouth when they cough or sneeze. Health Commissioner Robertson says that the public has been told how to protect itself, and that he sees no danger ahead.

September 26, 1918

In the last four days, 60 cases of pneumonia have been reported in Chicago.

Dr. C. St. Clair Drake, State Director of Public Health, orders all cases of the influenza reported to the local authorities. Drake also announces an order that only relatives may attend funerals of influenza victims.

Health Commissioner Robertson warns those sick to stay home until well. He also recommends that they stay warm so they can avoid contracting pneumonia. He asserts that it should be criminal for landlords to deny heat to tenants suffering from influenza.

September 27, 1918

Two deaths related to influenza are reported in Chicago. 20 more deaths are reported from pneumonia, but with no indication as to whether they are related to influenza. 57 new cases of flu reported.

Health Commissioner Robertson recommends that commuters on the “L” and streetcars wear gauze masks. He orders a number of Health Department employees to wear masks as a way to promote their use.

September 28, 1918

Medical section of the State Council of Defense receives orders from the National Defense Council in Washington to mobilize military and civilian doctors to combat the epidemic.

State Director of Public Health Drake says it is “inevitable” that theaters, schools, and places of public gathering will have to be closed.

Nurses will begin riding streetcars wearing masks in effort to promote their use.

September 29, 1918

Citizens living in north shore towns owning telephones are being asked to limit their calls to only those necessary because operators out sick with influenza.

State Director of Public Health Drake publishes an article in the Chicago Herald and Examiner compiling a series of suggested precautions. These include avoiding “coughers and sneezers” and crowded streetcars, covering one’s mouth when coughing or sneezing, and staying in bed until well, if sick with influenza.

September 30, 1918

The Emergency Medical Community issues a set of instructions for preventing and treating the flu, including: avoiding crowds; avoiding those who appear sick with a cold; staying warm; and covering your mouth when coughing or sneezing.

Health Commissioner Robertson orders a quarantine for every influenza victim. Every victim of the disease is commanded to go to his home and stay there. No visitors are to be allowed.

Dr. A. Augustus O’Neill, Chairman of the Advisory Committee representing the Red Cross and the Council of National Defense, receives a telegram with an urgent appeal for more physicians to work in the Chicago suburbs. Doctors’ pay will be comparable to that of army captains’ ($200/month plus expenses).

October 1, 1918

State Director of Public Health Drake orders all hospital staff to wear masks continually. Twenty-five West Side Hospital nurses are sick and three have died. Twenty-four nurses are sick at Presbyterian Hospital. There are reports of sick staff at Wesley and St. Luke’s hospitals. Peter Reinberg, President of County Board, closes County Hospital to all visitors except relatives wishing to visit those dying from other diseases.

October 2, 1918

County Hospital is full to capacity with 300 cases. Due to insufficient hospital space to house and isolate flu sufferers, authorities ask Chicago residents to volunteer their houses and businesses. Dr. O’Neill, Director of Red Cross says, “Temporary use of homes containing from fifteen to thirty rooms would prove a veritable God sends.” Authorities also ask for volunteers for ambulance service.

State Director of Public Health Drake issues an order excluding visitors from hospitals and other places holding influenza patients.

Charles H. Thorne, Director of State Public Welfare, instructs wardens of all state institutions to impose a quarantine of their establishments.

Theater owners are ready to show slides and cartoons that will educate public about the spread of influenza. They will also ask patrons showing signs of influenza (“persistent cough”) to leave.

Landlords are starting to be prosecuted for failing to provide heat to tenants. Police officers are arresting “promiscuous street-spitters.”

County school superintendents agree to impose a daily morning “sick call” at all schools.

October 3, 1918

City Health Commissioner Robertson asks the City Council to give $100,000 in emergency funding. He also asks newspapers to put out a call for all women with training in nursing to volunteer.

Numerous people have volunteered the use of their homes as makeshift hospitals. Jesse F. Goldberg has granted use of 15 of his apartments buildings.

Health Commissioner Robertson and State Director of Public Health Drake oppose closing city schools. Robertson, in an effort to allay the public’s fears, states that he would be surprised if the pneumonia death toll for 1918 was greater than that of 1917.

Many city officials are inoculated against pneumonia after Robertson receives 100 vials of serum for treating pneumonia from Washington D.C.

October 5, 1918

Health Commissioner Robertson orders health inspectors to visit churches and “demand” compliance with health regulations that have been imposed to stop the spread of the influenza. The health authorities threaten to close any non-compliant churches. Regulations include ousting churchgoers who show signs of influenza (coughing/sneezing), keeping the churches well ventilated and warm. Similar action will be taken in schools, theaters, restaurants, streetcars, L-trains, and other public places.

Health Commissioner Robertson warns against the free use of opiates to treat the influenza, and suggests seeking treatment from physicians.

The Chicago Osteopathic Association offers its aid to Robertson as well as to the military. The Association states that its members had previously offered their services, but had been ignored.

October 6, 1918

A list of eighteen precautions for avoiding influenza is published in the Chicago Herald and Examiner. Health officials publish several articles in a concerted effort to educate the public about influenza.

State Director of Public Health Drake states, “It cannot be too strongly emphasized that it is up to the individual if he wishes to avoid influenza….Health officials have laid down simple rules which should be rigidly followed. Just how soon this epidemic is to be broken in this section depends on the individual citizen.”

Health Commissioner Robertson calls a meeting with seven prominent local doctors. They agree to leave schools open, as well as all indoor gathering places.

October 7, 1918

Health Commissioner Robertson is optimistic that influenza has passed its peak. He notes that reports show that doctors are getting almost half as many calls for assistance as they had been receiving. He also criticizes State Director of Public Health Drake’s assertion that the number of infected in Chicago was 50,000 to 60,000, and that the death rate was 1% of those afflicted. Drake declines to be drawn into a controversy.

Robertson attends a meeting of physicians to deal with situation in Chicago. He also meets with engineers and principles from North Side schools regarding a report from health officials that they were not complying with the ban on “dry sweeping” and the need for proper ventilation.

The Federal Government gives permission to students entering college in Illinois to room in houses, rather than crowded barracks. Those in barracks will be given at least 50 square feet of space. “Sneeze sheets” will be placed between beds and opposite rows of eaters in the mess hall.

State Director of Public Health Drake reports that the Red Cross is ready to supply nurses and doctors as needed.

Cook County Hospital is poised to close its doors because of a dire shortage of nurses, even after cancelling time off for the nurses.

October 8, 1918

The Red Cross makes another “urgent” call for volunteer nurses.

October 9, 1918

Heads of thirteen civic and social communities, along with members of the president’s club, are appointed to assist the Health Commissioner Robertson in combating the epidemic. Dr. A. Augustus O’Neill, Medical Director of the Illinois Red Cross, convenes a meeting of six nurses associations in order to “marshal the nurses of the state.” He indicates that the nursing shortage had improved. Captain Moffett at Great Lakes Naval Training Station offers the services of hospital corps men and nurses to Chicago and Milwaukee.

The Chicago Herald and Examiner publishes a map indicating that ⅔rds of all influenza cases are north of Madison Street. Robertson says, “This shows the disease has come from the region of the Great Lakes. The stock yards district and its adjoining neighborhoods have surprisingly few cases.”

Head of the Chicago Association of Commerce, Lucius Teter, calls representatives of leading organizations together to combat the epidemic. Represented are various industrial, athletic, educational, and commercial organizations.

33 citizens are fined $1 for spitting on the elevated railway platforms.

October 10, 1918

State Director of Public Health drake initiates a public education campaign to slow the spread of the influenza. Movie picture and theater owners, ministers, and public officials are all asked to help. Slides are sent out to educate the public on how to fight influenza. Signs are posted on theaters warning that patrons showing signs of flu will be asked to leave. Ministers are to be given bulletins and asked to deliver influenza sermons. Mayors and health officers, as well as teachers, will be given material to pass out to public. Heads of businesses will be given material to post.

Illinois receives part of the million dollars made available by the government to fight the influenza epidemic. Assistance to towns and communities will be distributed through State Director of Public Health Drake and the local branch of the Red Cross.

Dr. Charles Foley, Assistant Superintendent of Dunning, the Chicago State Hospital for the Insane, reports that scores of patients have died at the institution.

The Women’s Committee of the State Council of Defense asks for cars to help transport nurses to homes.

October 12, 1918

The Columbus Day/Liberty Loan parade is held. The event is attended by President Wilson, the Governor of Illinois, the Mayor of Chicago, and draws a crowd estimated to be “more than a million.”

The Influenza-Pneumonia Commission (IPC) bans public dancing in dance halls, cabarets, and public places, as well as public attendance at funerals. Football games are also cancelled. The order applies to Chicago and the state at large. Schools and theaters, however, are kept open. Kids believed better off at school and theaters used to educate public.

President Budd of the elevated lines, along with Vice President Wilkie of the surface lines, will devise a plan to transport city workers in shifts to avoid overcrowding on the lines. Shoppers are asked to wait until after the morning rush hour to use lines.

A committee of 21 representatives of public and civic agencies and medical associations is appointed to help the Influenza-Pneumonia Commission.

October 13, 1918

The Influenza-Pneumonia Commission bans smoking on surface and elevated streetcars. The Commission believes that the ban, which opens smoking cars to non-smokers, will let passengers distribute selves throughout cars more evenly, and will also reduce spitting.

It is reported that deaths in Chicago in last month were the highest ever in the city’s history, with flu and pneumonia blamed for the increase in deaths.

County Hospital is only taking emergency cases. Other hospitals are close to capacity.

October 14, 1918

The Influenza-Pneumonia Commission meets to discuss closing places of public assembly—theaters, movie houses, pool halls, churches, etc. While all of the members of the commission agree that the closing should take place, they nevertheless delay their final vote. One reason given for the delay was the desire to consult with the Liberty Loan officials in order to determine how much revenue the government would lose from taxes levied on “amusement houses.”

The Influenza-Pneumonia Commission declares that all places of public amusement, including theaters and movie houses, are to be closed until the epidemic passes. Lodges and night schools are also closed. The Commission will take up the question of closing churches and convention halls.

October 16, 1918

J. Louis Guyon, the owner of the largest establishment (a dance hall) affected by closing, donates his advertising space on elevated car lines to health officials.

Chief of Police Alcock closes skating rinks, and the police are given power to decide which places of public amusement would be closed, beyond those named in order.

October 17, 1918

The Influenza-Pneumonia Commission orders that all places of public gathering “of a social nature” not essential to war be closed. It requests that church officials also discontinue public gatherings, though the committee falls short of ordering church closings. Cabarets serving as restaurants that do not detain patrons for entertainment will be allowed to continue. Also left open are saloons, bowling alleys and poolrooms, so long as they are “well ventilated.”

A new committee—the finance committee—will be created to raise money to fund the distribution of vaccine when it arrives in the city. The committee will be composed of bankers and wealthy businessmen.

October 18, 1918

Letters are sent to the chairmen of all the state’s political parties directing them to discontinue political gatherings.

Health Commissioner Robertson states that sports games and contests that draw crowds will be stopped, and all banquets, parties, club meetings, and conventions are to be discontinued. He also asks large employers to release 20% of their employees in 15 minute intervals, starting at 4:15 pm, and to start work in shifts at similar intervals in order to reduce crowding on streetcars.

The City Health Department begins making the influenza vaccine in its labs. Marquis Eaton, the local director of the Red Cross, is the first person in the city to be inoculated. The finance committee has already secured $25,000 to pay for the distribution of the vaccine.

October 19, 1918

Dr. H. N. Bundesen of the medical department reports that he has located the serum used in Boston to cure influenza patients. The Influenza-Pneumonia Commission meets to discuss the means of making the serum. The serum is made from the blood a “convalescent influenza patient.”

Health Commissioner Robertson adds playgrounds and hotel lobbies to the closing order. He also declares that city public schools are to become open-air schools as of Monday.

It is announced that eleven emergency kitchens will be opened in the city to help those who cannot get proper meals as a result of the epidemic.

The next draft call for Illinois is postponed.

October 20, 1918

As many as 14,000 people stand in line in Grant Park to participate in the “Smile Film,” a piece of propaganda meant to bolster troop morale.

Health Commissioner Robertson instructs religious leaders to hold services with windows and doors of churches fully open. Singing should be kept to a minimum and services should be kept to less than 45 minutes.

100,000 doses of influenza vaccine arrive from Minnesota. The Health Department will arrange to have hotels used to vaccinate the homeless. The vaccine will be administered for free by city officials, while private physicians will only be allowed to charge for the cost of their serves. Distribution is slated to begin tomorrow.

October 21, 1918

Forty cases of the flu and two deaths are reported for the Student Army Training Core at the University of Chicago.

There is an “urgent need” for more nurses. Health Commissioner Robertson asks physicians working for him to send 100 women between ages 50 and 60 to him to help care for the children of influenza victims. It is believed that women in this age group are immune to the disease. Hospitals agree to make more beds available to city’s influenza victims by opening beds in the surgical wards and limiting surgeries to only those necessary until the epidemic passes.

3,000 police reserves begin the process of enforcing the health regulations. The names of violators will be made public.

Because doctors are prescribing oranges to ward off the flu, their price has risen 60 cents per dozen. Illinois Red Cross Medical Director Dr. A. Augustus O’Neill recommends lemon juice and grapefruit juice as an adequate substitute for oranges.

October 22

While health officials report that the epidemic seems to be waning, Health Commissioner Robertson refuses to confirm that the peak has been reached. The Influenza-Pneumonia Commission believes the crest will be reached in next few days.

Due to limited supplies, influenza vaccines will be distributed to certain persons first: men in Class One of draft, then doctors and nurses serving influenza victims, and then general public. City labs begin producing their own batch of the vaccine. State labs are also preparing batches of the curative serum. Health Commissioner Robertson calls a meeting to urge heads of city hospitals and medical labs to join in the production of this serum.

Out of a newly reported contingent of 140 drafted mechanics at the University of Chicago, 30 develop influenza. As a result, the school is placed under quarantine.

October 23, 1918

Health officials ban athletic activities at prep schools, including football and military drills.

Health Commissioner Robertson threatens to revoke the license of any hospital refusing to admit influenza sufferers after hearing reports of such practices.

All vaccine supplies have been depleted. Robertson says city labs will have 100,000 more doses made by the weekend.

October 24, 1918

Health officials report that a survey of the city would show between 300,000 and 500,000 cases in Chicago. They believe there are many residents who have fallen ill, but are not ill enough to call a doctor. The southern part of the city is worsening, while the northern part is improving.

35,000 doses of vaccine are ready, with more due tomorrow. Chicago and Northwestern Railroad workers begin receiving vaccines.

Mrs. Ira Couch Wood, Chair of the Child Welfare Department of the State Council of Defense, issues an appeal for the loan of cars to help visiting nurses in their influenza work.

October 25, 1918

Authorities fix the prices of oranges and other foods, and female volunteers are to monitor compliance.

Large businesses, such as the Illinois Central Railroad, begin vaccinating their employees.

The 50th annual convention of the Illinois Equal Suffrage Association opens at the Congress Hotel. Only 100 delegates are to be admitted, and the general public is not allowed to attend.

October 26, 1918

The Elks Lodge provides free food to actors who cannot work on account of the ban against gathering at places of entertainment. Chief of Police Alcock reports that he will be looking into rumors that an attorney is writing theater owners and offering to represent them in court against the closing order of the Health Department.

According to President L.A. Busby of the surface streetcar lines, all cars will be put into service, despite the lack of healthy employees to operate them. Though 600 employees are sick, he rejects the suggestion that women be hired to address the worker shortfall, saying the Union would not approve. Busby notes that there are 200,000 fewer passengers riding the cars a day on account of the flu, costing his business $10,000 per day.

October 27, 1918

Chicago Billiard League’s three-cushion race is delayed for a week due to health ordinances. No tournaments will be held until ban on places of public entertainment or gathering is lifted.

Two men selling influenza cures on a South Chicago street corner draw a crowd, which the city police break up due to the order against congregations.

The Chicago Tribune reports that despite predictions from Washington, D.C. that Chicago’s death rate would be as high as 90/1,000, it has been halted at a peak of 63/1,000.

October 28, 1918

The Health Department lifts the ban on athletic games. Health Commissioner Robertson presents a tentative schedule for lifting the ban on public entertainment and gatherings at public places. He notes that any flare up of the outbreak will lead him to resume previous measures.

October 29, 1918

The ban on theaters, music and entertainment in restaurants, and political meetings is lifted. Theaters cannot open without written consent from the Health Department following a health inspection. However, all businesses must close by 10 pm. Because of the possibility of people catching a chill and contracting influenza, the Health Department reinstates its ban on sporting events.

Health Commissioner Robertson announces he does not intend to lift the ban on smoking, despite removing other restrictions as the epidemic wanes, explaining “It was essential to the quarantine that smoking on public conveyances be stopped. Now that the ban has been put upon it, the practice shall not be renewed. No other big city in the country permits it, and there is no reason why Chicago should tolerate it any longer.”

November 2, 1918

A new rule is put into place whereby police officers who become ill, even with influenza, will not be paid. Previously, ill officers were put on half-pay.

November 3, 1918

The only bans still in place are those on dances and athletic events. Still, all the theaters, cabarets, dance, and lodge halls must obtain permission from health officials before they can open.

The Influenza-Pneumonia Commission and streetcar officials meet to discuss rescinding the ban on smoking in the streetcars. It is believed that the ban will be extended for at least several weeks, maybe permanently. Health Commissioner Robertson seeks legal advice regarding the power of the Health Department to maintain the smoking ban.

Health Commissioner Robertson imposes a permanent ban on smoking cars on the elevated and surface lines. The Influenza-Pneumonia Commission backs the ban in the belief that there is a flu epidemic every two to three years and that by banning smoking they are taking steps to ward off next epidemic.

November 10, 1918

Health Commissioner Robertson asserts that the epidemic is over, “We are practically out of the woods. Chicago, so far as influenza and pneumonia are concerned, is the safest place in the United States.”

November 14, 1918

Alderman Sheldon Govier of the Ninth Ward introduces a bill directing Health Commissioner Robertson to withdraw the smoking ban on the “L.” Petitions are being circulated to have Mayor Thompson to rescind the order. Robertson indicates he will bend to the will of the majority.

December 3, 1918

Health Commissioner Robertson announces that the epidemic has returned. He calls for precautions and notes that the number of cases of flu and pneumonia are increasing. In a statement he says, “We will have influenza and pneumonia with us all Winter [sic] and probably for the next four years.”

It is announced that a penalty of $200 or imprisonment will be imposed for people contracting flu and failing to report it. Flu victims are also to be quarantined until 5 days after their temperature has passed.

December 4, 1918

Four movie theaters are closed for violating rules on ventilation. Health Commissioner Robertson sends a letter to all theater owners warning that violations of the anti-coughing and sneezing ordinances would lead to a re-imposition of the ban on theaters if not corrected.

December 5, 1918

Two large North Side theaters are closed on allegations of violating the ventilation ordinances.

December 6, 1918

404 new cases and 23 deaths from influenza are reported, along with 89 new cases and 16 deaths from pneumonia.

The six theaters closed over the past two days are allowed to reopen by Health Commissioner Robertson.

December 8, 1918

Alderman David R. Hickey of the Fourth Ward falls severely ill with pneumonia. City aldermen say that the spread of influenza is partially a result of the large amount of garbage and ash that is accumulating because the city lacks funds to support their removal by city workers.

Members of State Board of Health meet at the Hotel Sheridan to discuss legislative and administrative measures. They announce that the epidemic is in its second wave across the country, but that cases are milder.

December 9, 1918

Within the last week, the number of flu cases has almost doubled, with pneumonia cases having almost tripled. Health Commissioner Robertson notes that the new cases are milder than past ones, and that there is no real danger of a resurgence of the epidemic.

December 10, 1918

The American Public Health Association gathers at the Morrison Hotel and Hotel La Salle for a convention on the influenza epidemic. A number of committees are formed to focus on various aspects of the epidemic. Among the attendees is Health Commissioner Robertson, who also addresses the group.

December 11, 1918

Health Department reports show the epidemic is getting worse again, spreading in a North-to-South manner. North Shore towns, including Evanston, are especially hard hit.

In an attempt to calm the public, Health Commissioner Robertson issues the following statement: “While the disease is spreading there is not as much cause for worry as there was during the epidemic because the new cases are milder. Nevertheless, there is absolute necessity for the strictest observance of preventative measures.”

December 16, 1918

Health Commissioner Robertson urges residents to do their Christmas shopping early to avoid crowds and keep levels of stress in check.

December 19, 1918

The smoking ban on the elevated lines is to be continued for several months on account of the recent increase in cases of flu and pneumonia.

January 12, 1919

Health Commissioner Robertson declares his belief that half of the influenza deaths in Chicago and across the U.S. were the result of a lack of good nursing care.

The Health Department completes its survey of drug stores, and reports that during the height of the epidemic, physicians often prescribed medicines containing habit forming drugs such as opium. 441,641 prescriptions were written for influenza and pneumonia cases; of these, 104,010 were found to contain narcotics, including opium, morphine, codeine, heroin, and cocaine.

January 23, 1919

Chicago’s Board of Education orders an investigation into the health of the city’s children. The investigation is triggered in part over allegations of poor care, irregular visits to schools, and lack of cooperation with school nurses by doctors. Some allegations cover the period of time during the epidemic, but not all.

January 24, 1919

The Health Department starts a campaign to educate the city’s schoolchildren on ways to stop the spread of the influenza.

February 3, 1919

A milder and less deadly version of the Spanish influenza appears in the North Shore communities. Dozens of cases have cropped up in last 24 hours.

February 11, 1919

Health Commissioner Robertson makes the case that the reason there were fewer deaths from influenza in January versus December is that the weather was better and so more people got outside for fresh air.

March 1, 1919

It is reported that four people have contracted encephalitis lethargica, the “sleeping sickness” that followed the flu epidemic throughout England. Two victims are dead and the remaining two are expected to die. Victims appear to be sleeping, but cannot be awakened. Health authorities do not believe the sickness will reach epidemic proportions. The actual causes are not known, but authorities believe it springs from the weakened condition of flu victims.

March 11, 1919

Health Commissioner Robertson warns about the deadly after-effects of influenza, advising recovering patients to see their doctors frequently.

Chicago, Illinois

Image Gallery

Union Loop looking down Wabash Ave.Bird’s-eye view of the Chicago business district, with the North Western Railroad passenger terminal in the foreground.Advertisement for the Chicago School of Nursing. Nurses were in short supply and high demand during the epidemic.Map of the Cleveland, Cincinnati, Chicago and St. Louis Railway, showing the Windy City’s connections to the rest of the Midwest and the nation.